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Afghan mission causes spike in mental health cases

OTTAWA—Canadian soldiers went to Afghanistan equipped with gear such as fragmentation vests, helmets, ballistic eyewear and boots to protect against the physical dangers of combat.

Dr. Paul Sedge, a family doctor and psychiatrist the Department of National Defence, treats service members in Ottawa's Montfort Hospital. (Bruce Campion-Smith / Toronto Star)

But there was one protection the military couldn’t provide — Kevlar armour for the mind.

From the shock of a traumatic incident to the grief over fallen colleagues, the mental risks of serving in Afghanistan were perhaps even greater than the physical dangers. The daily stress of being under fire and facing danger in itself took a toll.

“There is the accumulation of stress just from deploying into an operational environment for six or seven months where you’re constantly in fear of driving over an (improvised explosive device) or being shot,” says Dr. Paul Sedge, a military psychiatrist.

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“Over time, that causes mental wear-and-tear injuries like major depression,” says Sedge, who holds the rank of major.

Working out of Ottawa’s Montfort Hospital, Sedge is among the dozens of military mental health professionals across Canada working the frontlines of the homefront, treating soldiers with the invisible wounds from their deployments in Afghanistan.

While some warn of a looming wave of mental illness in the forces, Sedge says that increase has already happened — and that the forces are coping with the caseload.

He says the military saw the numbers rise starting about a decade ago — the Afghan mission began in 2002 — and then continue after Canada’s mission moved from Kabul to take on a more dangerous role in Kandahar.

“What we’ve known from this war and previous wars is that the demand will continue probably for five to 10 years after the end of the mission,” Sedge says.

But he is encouraged that soldiers appear to be seeking help sooner after their return from war.

In the Vietnam War, Sedge says, studies showed that the interval between an exposure to a traumatic event and seeking treatment was about nine years. Part of that lag was because the stigma around mental illness made many reluctant to seek help.

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He says the Canadian Armed Forces has improved its own understanding of the issue in the wake of deployments to Bosnia and Rwanda.

“As we worked hard to increase mental health awareness through education and resiliency training and getting the word out that we’ve got the resources, that lag time is decreasing,” he says.

A study of soldiers from the base in Gagetown, N.B., who deployed in 2007 found that many sought help in the two years after their return, he says.

“I’m encouraged that I see more and more people coming forward for care and coming forward faster.

“We know as clinicians if people come in sooner with mental illness, you almost always have a better chance of treating them.”

Conversely, the longer post-traumatic stress disorder goes untreated, the greater the risk other problems will develop, such as addictions, marriage breakdown and depression, he says.

“That makes them harder to treat,” says the 30-year veteran of the forces.

But he stresses that treatment makes a difference.

“It is an illness that we can treat and people do get better,” Sedge says. “The majority improve.

“There are many success stories. I’ve personally had patients who were special forces or snipers, come in for treatment who had significant PTSD, recovered and redeployed to Afghanistan on a mission.”

Sedge says the level of mental health awareness and education in the armed forces far exceeds that in the civilian world. From recruits to generals, military personnel are schooled in the signs and symptoms of mental illness, how to manage stress, skills to deal with combat-related stress and how to recognize problems in a peer.

Yet the state of military mental health care has been in the spotlight, notably because of the suicides and the delay in hiring mental health professionals to fill vacancies to meet demand.

Yet Sedge says the health branch has the ability to bring in extra help or refer patients to outside professionals to deal with any backlogs. And he says that soldiers with mental health issues get quicker treatment than patients in the civilian health-care system.

A soldier who seeks mental health help can get an appointment with a psychiatrist in three to four weeks compared to a six- to nine-month wait in the civilian system.

“The resources provided for our service members are leagues above what’s available to the general population.”

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